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BackgroundThis multicentre case–control study aimed to identify risk factors associated with non-operative treatment failure for patients with CT scan Hinchey Ib-IIb and WSES Ib-IIa diverticular abscesses.MethodsThis study included a cohort of adult patients experiencing their first episode of CT-diagnosed diverticular abscess, all of whom underwent initial non-operative treatment comprising either antibiotics alone or in combination with percutaneous drainage. The cohort was stratified based on the outcome of non-operative treatment, specifically identifying those who required emergency surgical intervention as cases of treatment failure. Multivariable logistic regression analysis to identify independent risk factors associated with the failure of non-operative treatment was employed.ResultsFailure of conservative treatment occurred for 116 patients (27.04%). CT scan Hinchey classification IIb (aOR 2.54, 95%CI 1.61;4.01, P < 0.01), tobacco smoking (aOR 2.01, 95%CI 1.24;3.25, P < 0.01), and presence of air bubbles inside the abscess (aOR 1.59, 95%CI 1.00;2.52, P = 0.04) were independent predictors of failure. In the subgroup of patients with abscesses > 5 cm, percutaneous drainage was not associated with the risk of failure or success of the non-operative treatment (aOR 2.78, 95%CI − 0.66;3.70, P = 0.23).ConclusionsNon-operative treatment is generally effective for diverticular abscesses. Tobacco smoking's role as an independent risk factor for treatment failure underscores the need for targeted behavioural interventions in diverticular disease management. IIb Hinchey diverticulitis patients, particularly young smokers, require vigilant monitoring due to increased risks of treatment failure and septic progression. Further research into the efficacy of image-guided percutaneous drainage should involve randomized, multicentre studies focussing on homogeneous patient groups.

Endoscopic retrograde appendicitis therapy (ERAT) and its visually enhanced technique (Endoscopic direct appendicitis therapy, EDAT) represent a novel minimally invasive approach, offering advantages such as high-definition real-time visualization and precise intervention. This article reports a case of a 49-year-old male with acute appendicitis accompanied by an early abscess. CT findings suggested appendicitis with abscess formation, while EDAT exploration confirmed perforation at the appendiceal tip along with adjacent fecalith impaction, further verified by contrast imaging. During the procedure, the fecalith was extracted via EDAT, followed by irrigation of the purulent cavity and placement of a modified 7 Fr × 7 cm pancreatic stent for drainage. The patient experienced immediate symptom relief postoperatively, with serial follow-up CT scans on the procedure day, 3rd, and 7th postoperative days demonstrating gradual abscess resolution and normalized inflammatory markers, leading to discharge on day 3. A subsequent 3-month telephone follow-up revealed no recurrence of abdominal pain. This case illustrates that EDAT/ERAT can provide integrated diagnosis and definitive management for complicated appendicitis, avoiding the trauma associated with surgical intervention and offering valuable clinical insights.

Background Endoscopic ultrasound (EUS)- guided drainage has emerged as a novel technique for managing pelvic abscesses. This single-center retrospective case series aims to assess the safety and efficacy of EUS-guided drainage in treating pelvic abscesses of varying etiologies from 2021 to the present. Methods Consecutive patients with pelvic abscesses who underwent EUS-guided drainage were retrospectively reviewed. Etiologies included appendiceal abscess secondary to acute appendicitis ( n  = 1), pelvic abscesses resulting from anastomotic leaks following rectal cancer surgery ( n  = 2), and perianal abscesses associated with Crohn’s disease ( n  = 7). The primary outcome was technical success and reduction in abscess cavity size, assessed via follow-up imaging. Clinical success was defined as significant reduction or complete resolution of the abscess cavity size on follow-up imaging at one-month post-procedure, accompanied by clinical symptom resolution and without the need for additional interventions. Secondary outcomes included post-procedural complications and resolution of the abscess without additional interventions. Results EUS-guided drainage was technically successful in all cases. The median reduction in abscess size was statistically significant (Mean SD: 24.1 ± 11.11, p  < 0.05). During follow-up, imaging results confirmed significant reduction in the size of pelvic abscesses in 9 patients, except for one case at the 1-month post-procedure. None of the patients required further surgical intervention, and 2 cases recurrences were observed in the sixth- and tenth-months post-procedure. Additionally, no procedure-related complications were reported. Conclusion EUS-guided drainage is a safe and effective therapeutic option for managing pelvic abscesses of various etiologies. Its efficacy, particularly in Crohn’s disease-related cases, and the absence of complications in this cohort, suggest significant potential for broader clinical application.

OBJECTIVES: It is aimed to examine and determine the sociodemographic, clinical parameters and ultrasonographic (USG) findings and to make various predictions about patients who will need tube-ovarian abscess (TOA) surgery. MATERIAL AND METHODS: Within the scope of the study conducted between April 2016 and March 2021, 140 patients diagnosed with TOA were evaluated. The parties in the comparison were compared based on clinical and USG findings of demographic characteristics of the patients who received medical and surgical treatment and those who received only medical treatment. RESULTS: Ninety-eight (72.05%) patients whose surgical and medical treatment required underwent laparotomy, laparoscopy, and USG-guided drainage. The most important potential hazards for surgical procedures include severe abdominal pain, extent of abscess, and length of hospital stay. Critical threshold for a surgical procedure is when the abscess size becomes 5.5 cm (95% CI: 0.686–0.855, 0.686–0.855, p < 0.05). In the USG-guided drainage group no other complications were noticed. CONCLUSIONS: The size of the abscess is a valuable indicator of whether surgical treatment is required to manage TOAs and the USG-guided drainage led to fewer complications.

Background Splenic abscess is a rare disease, with incidence of 0.2–0.7% in previous studies. It often appears with left upper quadrant abdominal pain, fever, chills. Splenic abscess often happens because of hematogenous spreading of infections, endocarditis, angioembolization and some other rare reasons. Treatment relies on one of these two methods: percutaneous drainage or surgery. Case presentation A 68-year-old diabetic Asian female (Asian woman) presented with generalized abdominal pain, low blood pressure, tachycardia, fever, lethargy and elevated level of blood sugar. She had history of conservative therapy in intensive care unit due to blunt abdominal trauma and splenic injury. She had a huge splenic abscess in ultrasonography and computed tomography scan so she went under splenectomy. Our patient had a splenic abscess without performing any intervention like angioembolization. Conclusion Immune compromised patients who are selected for nonoperative management after splenic injury need close follow up and evaluating about abscess formation for at least 2 weeks. Early diagnosis and treatment with two methods including percutaneous drainage or splenectomy should be considered and it depends on patient’s risk factors, vital signs, general conditions and presence or absence of sepsis.

Falciform ligament abscess (FLA) is a rare occurrence as a consequence of local inflammation. This report presents a case of FLA on a background of recent cholangitis and laparoscopic cholecystectomy complicated by superficial umbilical wound infection. Diagnosis was by clinical examination and CT imaging. Management was by laparoscopic drainage.

BackgroundDiffusion-weighted magnetic resonance imaging (MRI-DWI) is the modality of choice for detecting intracranial abscesses; however, it is unclear whether prior brain surgery has an influence on its diagnostic value. Thus, we assessed the robustness of MRI-DWI and determination of an ADC cutoff value for detecting intracranial abscesses in patients who underwent brain surgery.MethodsWe retrospectively evaluated 19 patients prior to surgery for postoperative supratentorial parenchymal abscesses by means of MRI-DWI. Forty randomly selected patients with routine postoperative MRI-DWI were used for comparative analyses. Clinical and serum biomarkers (C-reactive protein, interleukin-6, white blood cell count) as well as from results of early postoperative imaging findings (computed tomography and/or MRI scan) were recorded. Additionally, ADC values, T1±gadolinium, and T2/fluid-attenuated inversion recovery sequences were investigated.ResultsAfter initial surgery, early postoperative control imaging showed evidence of hemorrhage and/or hemostatic agents within the resection cavity in 10/19 patients of the abscess group and in 16/40 patients of the control group. No postoperative ischemia was detected. Neither hemostatic agents nor blood affected the mean ADC values in both the reference group (blood 2.96 ± 0.22 × 10−3 mm2/s vs. no blood 2.95 ± 0.26 × 10−3 mm2/s, p = 0.076) and in the abscess group (blood 0.87 ± 0.07 × 10−3 mm2/s vs. no blood 0.76 ± 0.06 × 10−3 mm2/s, p = 0.128). The mean ADC value within the resection cavity was significantly lower in the abscess group (1.5 T 0.88 ± 0.41 vs. 2.88 ± 0.20 × 10−3 mm2/s, p < .01; 3.0 T 0.75 ± 0.24 vs. 3.02 ± 0.26 × 10−3 mm2/s, p < 0.01). The optimal ADC cut-off for the differentiation of an abscess from normal postoperative findings was found at 1.87 × 10−3 mm2/s (area-under-the-curve 1.0, sensitivity = 100%, specificity = 100%). Moreover, no differences between the abscess patients and the control group were seen with respect to the analyzed serum biomarkers.ConclusionMRI-DWI provides a robust tool to discriminate postoperative abscess formation from normal postoperative changes.

Purpose The first randomized clinical trial of antibiotics in uncomplicated diverticulitis (the AVOD study) showed no benefit of antibiotics. The aim of this study was to re-evaluate the computed tomography (CT) scans of the patients in the AVOD study to find out whether there were CT findings that were missed and to study whether CT signs in uncomplicated diverticulitis could predict complications or recurrence. Methods The CT scan images from patients included in the AVOD study were re-evaluated and graded by two independent reviewers for different signs of diverticulitis, including complications, such as extraluminal gas or the presence of an abscess. Results Of the 623 patients included in the study, 602 CT scans were obtained and re-evaluated. Forty-four (7 %) patients were found to have complications on the admitting CT scan that had been overlooked. Twenty-seven had extraluminal gas and 17 had an abscess. Four of these patients deteriorated and required surgery, but the remaining patients improved without complications. Of the 18 patients in the no-antibiotic group, in whom signs of complications on CT were overlooked, 15 recovered without antibiotics. No CT findings in patients with uncomplicated diverticulitis could predict complications or recurrence. Conclusion No CT findings that could predict complications or recurrence were found. A weakness in the initial assessment of the CT scans to detect extraluminal gas and abscess was found but, despite this, the majority of patients recovered without antibiotics. This further supports the non-antibiotic strategy in uncomplicated diverticulitis.